Want to hear an alarming statistic? By the year 2050, the number of Americans with diabetic retinopathy is expected to double—from 7.7 million to 14.6 million individuals. But becoming a statistic isn’t inevitable. Let’s take a look at what exactly diabetic retinopathy is, what causes it, and how you can treat—and even prevent—diabetic retinopathy in the first place.
Causes of Diabetic Retinopathy
Diabetic retinopathy is an eye condition that occurs when the blood vessels in the retina (the back part of the eye that enables us to see) become damaged, causing them to bleed or leak fluid. It’s caused by chronically elevated blood sugar. The longer the duration of high glucose levels, the greater the likelihood of developing diabetic retinopathy. Left untreated, it can eventually lead to vision impairment or diabetic retinopathy blindness, which is why it’s important to get a handle on high blood sugar early, before it reaches the most advanced stage.
Who Is at Risk of Diabetic Retinopathy?
Diabetic retinopathy can occur in people with both type 1 and type 2 diabetes, as well as gestational diabetes. Men and women are almost equally affected. Roughly 40-45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, yet only about half are aware of it. Women who have diabetes, or develop it during pregnancy (gestational diabetes), may have rapid onset or worsening of the symptoms of diabetic retinopathy.
As noted, if you have diabetes, you are at increased risk of developing diabetic retinopathy. Your risk can also increase as a result of these other factors:
- Longer duration of diabetes
- Poor control of blood sugar levels
- High blood pressure
- Elevated cholesterol
- Tobacco use
- African American, Hispanic, or Native American heritage
Symptoms of Diabetic Retinopathy
In the early stages of diabetic retinopathy, there may be no signs. But as the condition becomes more advanced, symptoms become evident. These symptoms include:
- “Floating” spots
- Changes in vision
- Blurry vision
- Impaired color vision
- Dark or empty areas in your vision
- Loss of vision
Because not everyone with diabetic retinopathy will experience symptoms right away, it is very important for people with diabetes to get comprehensive eye exams, with dilation, annually. During an eye exam, a physician performs the following diabetic retinopathy tests:
- Visual acuity – This test uses an eye chart to measures a patient’s sight at various distances.
- Pupil dilation – With the eyes dilated, drops are placed in the pupil to examine the retina and optic nerve.
- Tonometry – This test measures the amount of pressure inside the eye.
- Optical coherence tomography – Using noninvasive imaging, light waves capture cross-section images of the retina.
Stages of Diabetic Retinopathy
Diabetic retinopathy can progress through four stages, which range from mild to advanced, and can eventually lead to retinal detachment and vision loss. The four stages of diabetic retinopathy are:
- Nonproliferative Retinopathy: This is the earliest, mildest stage and is marked by microaneurysms, which are minute areas of balloon-like swelling in the retina’s tiny blood vessels. These microaneurysms have the potential to leak fluid into the retina.
- Moderate Nonproliferative Retinopathy: During this stage of progression, the tiny blood vessels that nourish the retina may swell and distort. In addition, they can lose their ability to transport blood.
- Severe Nonproliferative Retinopathy: As the disease progresses it causes many more blood vessels to become blocked and in turn deprives the blood supply to the retina.
- Proliferative Diabetic Retinopathy (PDR): During this fourth, and most advanced, stage blood vessels in the eye become obstructed due to a lack of oxygen. As a result, growth factors cause new fragile blood vessels to form in the retina and into the vitreous or the gel-like fluid that fills the back of the eye. The fragile new blood vessels that form may leak blood in the vitreous, clouding vision. In addition, these delicate vessels may also pull on the retina, leading to retinal detachment and vision loss.
Prevention, along with early diagnosis and treatment of diabetic retinopathy, are very important.
Standard Diabetic Retinopathy Treatments
Diabetic retinopathy treatments are typically not started until the disease progresses to proliferative diabetic retinopathy, the most advanced stage. The treatment involves a scatter laser surgery where 1,000 to 2,000 tiny laser burns are made to the areas of the retina away from the macula.
The purpose of this treatment—which can take one, two, or more sessions—is to shrink the abnormal blood vessels in the eye in size. Scatter laser surgery for the treatment of diabetic retinopathy has been shown to be successful for central vision. However, it may cause some loss of peripheral (side), night, and color vision.
Noninvasive Diabetic Retinopathy Treatments
Surgeries and other invasive interventions should be a last resort. Instead, patients who have diabetic retinopathy should be treated with targeted nutritional supplements (see below) as well as other therapies that support all aspects of ocular, nerve, and blood sugar health.
- Hyperbaric Oxygen Therapy (HBOT): HBOT is administered in a specially designed pressurized chamber. When 100 percent oxygen is inhaled in this environment, it is easily absorbed, even in areas where blood supply is limited. This infusion helps boost circulation and improves a wide number of conditions, including diabetic complications such as retinopathy. In fact, because HBOT helps to stop the blood-retinal breakdown, the Undersea and Hyperbaric Medical Society lists diabetic retinopathy as an approved condition for this therapy. Click here to find a location near you that offers HBOT.
- Enhanced External Counterpulsation (EECP): EECP increases blood flow and enhances arterial health and function in blood vessels throughout the body, including the eyes. Best known as a treatment for coronary artery disease—perhaps the most serious complication of diabetes—it also reduces symptoms of other diabetes-related disorders, including diabetic retinopathy and peripheral neuropathy. During 35 one-hour sessions, pressurized cuffs are placed around the lower extremities. With each beat of the heart, the cuffs contract, squeezing blood up toward the heart and throughout the body. In a recent study, participants who underwent 35 EECP treatments a year for three years were able to slash their risk of developing proliferative diabetic neuropathy by a whopping 86 percent.
- Intravenous (IV) Nutrients: When vitamins, minerals, and other nutrients are infused intravenously (IV), or directly into the bloodstream, they bypass the potential loss of potency and poor absorption in the gastrointestinal tract characteristic of oral nutrients. This makes IV administration a powerful, yet overlooked, therapy for numerous health concerns, including diabetic retinopathy. To support ocular health, we give patients specialized blends of antioxidants, minerals, and amino acids that help ward off or improve degenerative vision problems. Among these nutrient powerhouses are high doses of IV vitamin C and the antioxidant glutathione.
To find a physician knowledgeable about these treatments, visit The American College for Advancement in Medicine.
Prevention of Diabetic Retinopathy
As the proverb goes, an ounce of prevention is worth a pound of cure. It is very important for people with diabetes to get comprehensive eye exams at least once a year because early prevention of diabetic retinopathy can reduce the risk of vision loss. In addition, careful management of blood sugar and blood pressure are critically important.
There are also important diet and lifestyle components that play a key role in diabetic retinopathy prevention:
- Eat a Healthy Diet: Avoid sugary foods and highly processed carbohydrates, and opt for fiber-rich, low-glycemic vegetables and legumes, moderate protein, and healthy fats to keep blood sugar on an even keel and diabetes at bay.
- Exercise Regularly: Recent studies have shown that physical activity reduces the risk of diabetes by 50-80 percent . Even a short walk after meals can go a long way toward helping manage blood sugar levels.
- Keep Cholesterol and Blood Pressure in Check: Clinical trials demonstrate that people with high blood pressure and elevated cholesterol levels are at increased risk of developing diabetic retinopathy.
Furthermore, to protect your eyes from diabetic retinopathy and other vision problems, you need to make sure you’re getting nutrients that support the health of your blood vessels.
When blood glucose levels remain elevated for an extended time, sugar molecules can attach to protein molecules in a process called glycation. This process creates irreversible cross-links between adjacent protein molecules and forms new structures called advanced glycation end products (AGEs). Among other things, AGEs can cause the collagen in our blood vessels to become stiff and inflexible. The tiny vessels in our eyes are particularly susceptible to this type of damage.
L-carnosine is a powerful antioxidant that can prevent this from happening. L-carnosine is a natural combination of the amino acids beta-alanine and L-histidine and it is considered the strongest glycation-inhibiting agent ever discovered. It also is believed to bind and modify AGEs that have already formed, which helps the cells target them for removal.
The best way to take L-carnosine is by using special eye drops that contain it. The suggested dose is 1 to 2 drops in each eye daily. If you have a degenerative eye condition, check with your physician before using them.
And, last but certainly not least, targeted nutritional supplements play a key role in diabetic retinopathy prevention. The right combination of vision-supporting nutritional supplements can help ward off vision problems:
- Lutein: A naturally occurring carotenoid abundant in green, leafy vegetables, such as spinach and kale, as well as egg yolk. Lutein is highly concentrated in the macula, with smaller amounts found in the retina, lens, and optic nerve. Numerous studies have shown the benefits of lutein to keep your eyes healthy and vision sharp. Aim for 20-40 mg of supplemental lutein daily.
- Coenzyme Q10 and Omega-3s: These supplements are effective in maintaining normal blood pressure, which helps to ward off diabetic neuropathy and retinopathy. I recommend taking a good coenzyme Q10 (CoQ10) supplement, as well high-quality omega-3 supplements derived from fish, squid, or krill. The suggested dose of CoQ10 is 100-200 mg per day.
- Berberine: This potent plant compound, found in a variety of exotic plants including Oregon grape, Chinese goldthread, and barberry, has been proven in clinical trials to help lower blood sugar. A landmark study published in the journal Metabolism, included people with newly diagnosed type 2 diabetes. They were randomly divided into two groups and assigned to take either metformin (Glucophage) or berberine. After the very first week, improvements were noted in the group that took berberine, and at the study’s conclusion, the average blood sugar levels and hemoglobin A1C levels decreased significantly in both groups. However, when a nutritional supplement performs as well as a prescription drug, it will always be my frontline recommendation. The suggested dose of berberine is 500 mg, two to three times per day.
- Pycnogenol: Pycnogenol is a versatile supplement obtained from French maritime pine bark. An exceptionally potent antioxidant, it protects the blood vessels and capillaries from free-radical damage. This phytochemical also stimulates the production of nitric oxide, which improves blood flow and enhances overall arterial function. In a clinical trial involving patients with early diabetic retinopathy, taking 150 mg of Pycnogenol daily for three months improved retinal blood circulation and edema, resulting in improvements in vision. The suggested dose is 150 mg per day.
- Grape seed extract: This antioxidant protects blood vessels and capillaries from free radical damage. The recommended dose is 1 mg per pound of body weight (round your weight up or down to the nearest 50 pounds), in divided doses with meals, for the first week. Then continue with a maintenance dose of half that amount. For example, if you weigh 210 pounds, take 200 mg a day for the first week, and then continue taking 100 mg a day.
- Benfotiamine: This fat-soluble, highly absorbable form of thiamine (vitamin B1) blocks three of the major culprits responsible for blood vessel damage. As a result, it helps prevent diabetic retinopathy. The recommended dose is 300 mg per day.
- Magnesium: Studies show that people with the lowest levels of this important mineral are the most likely to have severe diabetic retinopathy. Take 500–1,000 mg per day.
Diabetic Retinopathy Recap
I can’t stress enough how important it is to take steps to manage your blood sugar to prevent the symptoms of diabetic retinopathy. The good news is diet, exercise, nutritional supplements, and noninvasive therapies can make a world of difference in diabetic retinopathy prevention and treatment.